About Glaucoma.

Glaucoma can be a "silent threat" to your vision. The most common form is completely painless and slow to progress. This disorder, even once diagnosed, may cause irreversible optic nerve damage and blindness - and so should be taken seriously. When glaucoma is detected early and treated with the proper medication, vision can usually be preserved. Our eye surgeons are New Jersey glaucoma specialists. They have helped thousands of New Jersey area patients retain good vision either through drug treatment or glaucoma surgery.

What is Glaucoma?

Glaucoma is not a single condition. The term refers to a group of conditions commonly associated with too much pressure in the eye. Many organs in our bodies have their own pressure, or hydraulic systems, in which fluids are routinely pumped from one place to another, the most common being the heart, which pumps blood via the arteries to all areas of the body, while returning blood makes its way back via the veins. The brain, pancreas, gallbladder, among other organs, all have their own hydraulic systems.

The fluid inside our eyes circulates to enrich its various components with vital nutrients. The cornea (front clear portion of the eye) and the crystalline lens (behind the pupil) receive no blood circulation and thus must depend on the eye’s unique circulatory system to bring nourishment by way of fluid called "aqueous".

Inside the eye, there are normal pressure ranges for the aqueous flow, just like there is a normal pressure range for blood flow. When the aqueous pressure gets too high in the eye, damage may occur to the sensitive nerves in the back of the eye and loss of vision can result.

What Causes Glaucoma?

The structure of your eye and its relation to glaucoma can be compared to the plumbing of your kitchen sink, where there is a faucet, a space for the water to flow, and a drain to carry the fluid away. However, the sink is an open system, meaning it can overflow if too much liquid were to occur. In contrast, the eye is a closed system; no overflowing, no place for excess liquid to go. Therefore, when the flow of fluid inside the eye is interrupted for any reason, the pressure within the sphere will go up.

Glaucoma can be caused by too much inflow (the faucet is running too fast) and/or not enough outflow (the drain is blocked). In either case, the pressure within the closed sphere of the eye goes up, pushing on the delicate nerves at the back of the eye and possibly causing permanent damage.

How Does Too Much Fluid Accumulate?

There are many reasons why too much fluid may accumulate inside the eye. The drain in the eye is called the "trabeculum", a specialized tissue located in front of the iris (the colored part of the eye), a circular shape that channels aqueous away from the eye and the eye socket (orbit).

Primary open angle glaucoma: When the trabeculum becomes less porous and causes aqueous fluid to be blocked, it resembles a clogged kitchen sink drain. It does not allow fluid to pass at the normal flow rate and (being a closed system) the pressure in the eye rises. This is the most common type of glaucoma and is called "primary open angle glaucoma" (POAG) or "chronic open angle glaucoma" (COAG).

Angle recession glaucoma: If the delicate drainage tissue in the trabeculum becomes damaged from injury, then the filtration of the aqueous fluid may be blocked. This is called "angle recession glaucoma". This type of glaucoma might be common in boxers or athletes who have had inadvertent damage from a severe blow to the eye.

Narrow angle glaucoma: When the trabeculum gets blocked by other tissues, the iris (colored portion of the eye) can block the drainage tissue leading to increased pressure. This is called "narrow angle" or "angle closure glaucoma".

Loose tissue blockage: Various loose tissue in the eye can block the drainage tissue. This loose tissue might be tiny fragments of the lens capsule (exfoliation glaucoma), pigment from the back of the iris (pigment dispersion glaucoma), or cellular particles and debris from inflammation (uveitic glaucoma) within the eye.

Caused by medication: The pressure can be elevated as an unexpected response to certain medications such as steroids/prednisone. A small percentage of people who take these medications can be particularly susceptible this. These patients of glaucoma are called “steroid responders" .

How is the Type of Glaucoma Determined?

There are series of tests done during the examination of your eye that can help the doctor determine whether you have glaucoma and, if so, what type of glaucoma it might be.

The first and most common test is a measurement of the pressure in the eye. This is done with a special instrument that touches your eye and measures the pressure inside your eye. Your doctor instills an anesthetic eyedrop so that you will not feel the instrument. This is a very gentle test, but essential for knowing whether the pressure is elevated in your eye.

The second test is an evaluation of the drainage tissue, or trabeculum. This is usually done with a special lens that is gently applied to the eye and allows the doctor to visualize the trabeculum drainage tissue. Once this is seen, a decision can be made as to what type of glaucoma you might have.

The third test is an evaluation of the optic nerve, which is the large nerve tissue in the back of the eye. The optic nerve acts as a conduit for all of the smaller nerves from the retina that carry impulses of light to the brain, where the vision is actually developed or processed into our sight. Glaucoma causes fairly typical changes to the large nerve head at the optic nerve, and these changes usually signal the presence of glaucoma.

What Special Tests Help Evaluate Glaucoma?

Specialized tests which allow a very detailed evaluation of glaucoma so that a great deal can be learned about your eye, whether you might have lost vision from glaucoma, and how much vision might have been lost.

The most common test is the “visual field test". This is done on a computer driven machine. The test usually takes a few minutes per eye, it is painless, and the machine is like a large cup turned on its side. You, the patient, looks into the center of that large cup and signal when a light is seen to the side. This measurement of peripheral vision is the most critical way of showing how much vision might have been lost by glaucoma.

There are also tests of the optic nerve. These tests can measure the number of nerves in the optic nerve packet, comparing this number to normal known numbers, and over time, whether this quantity of nerves is decreasing as might occur if the glaucoma is actively causing damage.

At our office at 3001 Chapel Avenue in Cherry Hill, New Jersey, we have all of these machines and routinely perform all of these tests to evaluate our patients whom might have glaucoma.

How is Glaucoma Treated?

Eyedrop medications are the mainstay of glaucoma treatment. There are several families of these eyedrops; some work to make the drainage tissue (trabeculum) more porous and efficient so that the aqueous fluid passes more easily. Other eyedrops turn the faucet down, decreasing the inflow of aqueous fluid into the eye. There are combination medicines that may contain some of the outflow enhancer and some of the inflow reducer.

Some of these medications need to be given once a day, others may need to be administered to the eye 2, 3, 4 or even more times to the eye, depending on the need to reduce the pressure.

What If Eyedrops Don't Help?

We have a variety of ways of treating an eye when the pressure is too high. If the eyedrops do not control the pressure, we may prescribe medication in a pill form. This usually a short term treatment, but some patients may need these pills indefinitely.

We may recommend treatment of a glaucoma problem with laser. Lasers can be used to improve the outflow of the drainage tissue (make the trabeculum pass the aqueous better). Lasers may be used to unblock the trabeculum drainage tissue if the iris is covering it. This type of laser is used to treat "angle closure glaucoma". Lasers can also be used within the eye, especially if our patients are undergoing cataract surgery and also have glaucoma, allowing a convenient opportunity to treat the aqueous producing cells and thus "turn down the faucet."

Is There Surgery for Glaucoma?

Eye surgery is sometimes necessary to treat glaucoma when eye medications or laser treatments are not adequately controlling the pressure in the eye, or when our patients cannot use these forms of treatments. Some patients, for example, may be allergic to the medications, or the medications are not enough to bring the pressure down in the eye. When this happens and the glaucoma is seriously threatening the eye with blindness, then glaucoma eye surgery may be necessary.

Glaucoma eye surgery is a delicate procedure that aims to improve the aqueous fluid outflow from the eye. A new channel may be made to carry the aqueous out of the eye (trabeculectomy) or an artificial drainage device is put in the eye to bypass the normal drainage tissue and creates a new conduit for fluid to exit the eye. There are various techniques and options available for all of these drainage enhancing strategies.

The test for glaucoma is painless and is an important reason to schedule a yearly eye exam. At Kindermann Eye Associates, we are glaucoma specialists. Contact us for your glaucoma examination.

(856) 667-3937

Kindermann Eye Associates
3001 Chapel Avenue, Suite 200
Cherry Hill, New Jersey 08002